Provider Demographics
NPI:1629126768
Name:LOO, KEVIN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:LOO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 S BERETANIA ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2551
Mailing Address - Country:US
Mailing Address - Phone:808-524-1102
Mailing Address - Fax:808-599-4696
Practice Address - Street 1:848 S BERETANIA ST
Practice Address - Street 2:SUITE 305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2551
Practice Address - Country:US
Practice Address - Phone:808-524-1102
Practice Address - Fax:808-599-4696
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-22101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics